Fig 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Lipoma in a 54-year-old woman who complained of a palpable nodule in her left medial arm for more than 1 year. Longitudinal section ultrasonography shows a heterogeneous echoic nodule with well-defined margins (arrows) in the left medial arm; parallel echogenic lines (arrowheads) were observed within the tumor.
Source publication
Surgical removal and clinical follow-up of soft tissue masses are easily managed in clinical practice but are dependent on the experience of the clinician. Occasionally, however, a patient is referred from a local clinician to our clinic with an inoperable mass following a surgical procedure. We consider it important to fully understand the nature...
Contexts in source publication
Context 1
... growth [14]. Most lipomas occur in the superficial soft tissues and are generally slightly hyperechoic relative to the surrounding fat lobule or muscle; however, they sometimes appear isoechoic or hypoechoic [15]. In our experience, most lipomas present specific patterns of "parallel echogenic lines" or focal homo- geneous hyperechogenicity (Fig. 2). On CDUS, most lipomas present as avascular; weak vascular- ity is observed within the tumor in a small number of ...
Context 2
... characteristic US findings of tenosynovitis are anechoic or hypoechoic peritendinous fluid with synovial thickening and increased vascularity [47]. The typical patterns in tenosynovitis are heteroge- neous hypoechogenicity, lobulated contour, mod- erate size, mild to moderate hypervascularity on CDUS, and fluid accumulation along the tendon (Fig. ...
Context 3
... US appearance of hernia depends on the con- tents of the hernia sac and the presence of a bowel loop; real-time ultrasonography readily demon- strates peristalsis or dilatation of the bowel loop (Fig. 22). If there is fat content, the US pattern is of sliding mesentery fat during the Valsalva maneu- ver. If muscle has herniated, the typical pattern is A B defect in the epimysium with protrusion of muscle perimysium during muscle stress (Fig. ...
Context 4
... loop; real-time ultrasonography readily demon- strates peristalsis or dilatation of the bowel loop (Fig. 22). If there is fat content, the US pattern is of sliding mesentery fat during the Valsalva maneu- ver. If muscle has herniated, the typical pattern is A B defect in the epimysium with protrusion of muscle perimysium during muscle stress (Fig. ...
Context 5
... US pattern in lymphadenitis is heter- ogeneous hypoechogenicity, well-defined margins, ovoid contour, solid content, small to moderate size, moderate to marked hypervascularity of the hilum on CDUS, and moderate RI. Most patients presented with a hilum within the lesion, some with several nodules and increased echogenicity surrounding the fat (Fig. 24). ...
Context 6
... typical ultrasonographic pattern is of heter- ogeneous hyperechogenicity, ill-defined margins, lobulated contour, solid content, moderate size, and mild vascularity on CDUS. Most lesions are associated with echogenic spots caused by calcifi- cation or urate crystal deposition distributed along the tendon, sometimes with overhanging bony erosion (Fig. ...
Context 7
... soft- tissue nodules, and a hypoechoic rim around the tendon [48]. In our experience, the appearances in most patients are heterogeneous hypoechogenicity, well-defined margins, lobulated contour, solid con- tent, moderate size, moderate vascularity on CDUS, and moderate RI. Other features, such as pannus for- mation and bony erosion, may be found (Fig. ...
Context 8
... in the long head of the biceps tendon. The ultrasonographic appearance in most patients is heterogeneous hyperechoic on the muscle retrac- tion side, ill-defined margins, ovoid contour, solid content, moderate size, and avascular or hypovas- cular on CDUS. It is sometimes associated with heterogeneous blood clot or echo-free fluid accu- mulation (Fig. ...
Context 9
... origin of most metastases is from carcinoma, rarely from sarcoma. Most are moderate or large in size, with heterogeneous hypoechogenicity, infil- trated margins, scalloped contour, solid compo- sition, moderate hypervascularity on CDUS, and moderate RI. Tumors located close to the bony cor- tex commonly result in surrounding bony destruc- tion (Fig. ...
Context 10
... present with heterogeneous hyperechogenicity, infiltrated margins, scalloped contour, solid composition, large size, moderate hypervascularity on CDUS, and moderate RI. Surrounding bony destruction, bony fragments, and sunburst periosteal reaction is observed in most patients. OGS occurs most commonly in the lower limb, especially the knee joint (Fig. 29). Recurrence of OGS may appear as a well-defined ovoid hypoechoic nodule that differs from the original ...
Context 11
... type, the typical presentation is multiple small hypoechoic nodules with hypervascularity. In the cellulitis type, the typical presentation is echogenic subcutaneous fat lobules, ill-defined margins, and hypervascular- ity. Our previous study [11] found that the mass and nodal types are the most common types of peripheral soft tissue lymphoma (Fig. ...
Citations
... El principal síntoma es una masa dolorosa de crecimiento rápido, que produce elevación y deformidad del aspecto dorsal de la uña y pueden simular onicomicosis (21). En ecografía se ven como estructuras hiperecoicas, con marcada sombra acústica posterior, que se extienden desde la falange hasta el plato dorsal y ventral (22)(23). ...
RESUMEN En la actualidad, con el desarrollo de transductores lineales de alta resolución, la ecografía de uña ha tomado relevancia en la caracterización de lesiones traumáticas, tumorales e infecciosas, brindando al médico información útil para el manejo clínico, conducta quirúrgica y seguimiento de las mismas. En este artículo se realiza una descripción general de la anatomía y patología de la uña, con énfasis en su presen-tación ecográfica. Las imágenes presentadas corresponden a pacientes evaluados en consulta externa en nuestra institución, a quienes se les practicó ecografía del aparato ungueal con transductor lineal de alta resolución, con correlación clínico patológica de las imágenes obtenidas. Palabras clave: ultrasonido de uña, glioma ungueal, ecografía, onicomicosis, exostosis ungueales. SONOGRAPHY EVALUATION OF THE NAIL UNIT ABSTRACT Today with the development of high-resolution linear transducers, ultrasound of nail has gained relevance l in the characterization of traumatic injuries, tumor and infectious, providing useful information for clinical management, surgical treatment and monitoring of the same. In this article we do a general description of the anatomy and pathology of the nail with emphasis on sonographic presentation. All cases presented correspond to outpatient patients evaluated at our institution, who had been practicing ultrasound of ungueal apparatus with high-resolution linear transducer with clinic pathologic correlation of images obtained.
... The US examination demonstrates a band-like hyperechoic structure with a posterior acoustic shadowing artifact and connected to the underlying bony margin (Supplemental Figure S11). 68 Onychocriptosis This is the embedding of the nail plate into the periungual nail fold. The US examination shows the hyperechoic bilaminar fragment in the periungual region and the hypoechoic inflammatory in the surrounding tissue. ...
Complete visualization of lesions is critical for the accurate diagnosis and management of dermatological diseases. Currently, the most readily available technologies used by dermatologists include dermoscopy and photography. Nevertheless, ultrasound has emerged as a useful non-invasive modality in dermatology, which can be added to the clinical examination supporting an early and more accurate diagnosis. Moreover, there are significant technological advances in recent years, such as the development of handheld devices and ultra-high frequency probes that have expanded the integration of ultrasound into daily dermatology practice. In this article, we reviewed the most common applications of ultrasound in the field of dermatology.
... USG helps in providing characterization of solid, cystic and mixed lesions, their sizes, margins, volume, relation with surrounding structures and compartmental localization of the mass lesion 3 . Application of high resolution ultrasound in soft tissue pathologies of musculoskeletal system has evolved exponentially in the past two decades and is useful in not only evaluating the nature of soft tissue swellings but also aids in detection of histology in mostly all cases 4 . Apart from providing the nature and characteristics of swelling, ultrasound helps the surgeon for appropriate surgical management with least complications. ...
... The US appearance is consistent with band-like hyperechoic heterogeneous structures with posterior acoustic shadow, well-defined margins, calcifications, and a hypoechoic cap corresponding to cartilaginous tissue that may surround it [23,28]. Hypovascularity or a mild vascularity may be seen with Doppler color US (Fig. 10) [51]. US can be helpful in the differential diagnosis, especially with onychomycosis that may have similar clinical characteristics. ...
IntroductionThe nails have a functional and esthetic importance for patients. Almost always, the nail disorders are diagnosed on the basis of clinical findings, but imaging methods may be required for a better assessment. These imaging methods, such as ultrasound and magnetic resonance, may help to establish an accurate diagnosis. Magnetic resonance imaging is not widely available and sometimes may be very expensive; that is why, ultrasound is an excellent imaging modality. Our objective is to expose the nail unit anatomy, the nail unit anatomy in ultrasound, and some of the frequent pathologies found in our daily practice. MethodsA review of the literature was done to review the anatomy, technical aspects, and different findings in normal and abnormal nail unit ultrasound. ResultsUltrasound offers an appropriate alternative for the evaluation of the nail unit, allows a real-time evaluation of each one of the components of the nail unit with an optimal visualization of these structures, and allows the evaluation of the thickness of the components, the vascularity, and blood flow by Doppler application. In addition, the nail unit disorder, such as infectious diseases, inflammatory and rheumatologic conditions, nail tumors, among others, may be assessed, not only in the diagnosis but also in the follow-up. Pre-surgical evaluation, surgical follow-up, and some procedures, such as biopsies, may be done by this technique. Conclusions
Ultrasound is an excellent technique for evaluation of normal anatomy, diagnosis, and follow-up of patients with nail unit diseases. This is an alternative for other imaging methods and may be used for an accurate diagnosis approach.
... Gray-scale and color Doppler US play an important role in the diagnosis of soft tissue tumors. Despite the fact that no specific finding is present to differentiate between benign and malignant lesions, color Doppler US may be useful for evaluating the internal vascularity of the lesion [26,27]. ...
... The subcutaneous lesion demonstrated well-defined margins and a heterogenous echo pattern with scattered punctate echogenic foci causing TAs (Fig. 13). Welldefined margins, ovoid contour, internal echoes due to the presence of keratinous debris, and avascularity on color Doppler US are typical US findings of epidermoid cysts [26]. In this instance, keratinous debris may be considered to be the source of TA in our case of epidermal inclusion cyst. ...
The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.
... The characteristic appearance of pseudoaneurysm in upper extremities arterial vessels is the extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and "to-and-fro" flow pattern on color Doppler ultrasonography (CDUS) [49,50] . It has been estimated that 2% to 3% of pseudoaneurysm in Subclavian artery occur due to blunt trauma, or injuries after clavicle fracture [51] . ...
Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.
... Our gray-scale US data, collected 3 days after symptom onset, showed a myositis-like appearance [18]. An intramuscular heterogeneous hyperechoic mass lesion with cystic formation and hypervascularity was found in the right iliopsoas abutting the surface of the right femoral bone. ...
We report here the case of a 32-year-old man with a history of traumatic brain injury who presented with swelling of his right thigh. Soft tissue ultrasonography performed 3 days after the onset of symptoms showed a heterogeneous hyperechoic lesion with the formation of cysts and hypervascularity in the right iliopsoas abutting the surface of the femoral bone. This became a diffuse echogenic plaque with a posterior acoustic shadowing 12 days later. A diagnosis of heterotopic ossification was made on the basis of the presence of typical ultrasonographic findings and was confirmed by pathology. We emphasize that an early diagnosis of heterotopic ossification can be made with ultrasonography and can lead to early treatment.
... Early diagnosis of soft tissue malignancies is important, as it improves survival (35)(36)(37). Thus the aim of this study was to investigate the ability of CAD for differentiating lipoma from liposarcoma and to compare its performance with radiologic interpretation by experienced subspecialists. ...
Rationale and Objectives
To determine if differentiation of lipoma from liposarcoma on magnetic resonance imaging can be improved using computer-assisted diagnosis (CAD).
Materials and Methods
Forty-four histologically proven lipomatous tumors (24 lipomas and 20 liposarcomas) were studied retrospectively. Studies were performed at 1.5T and included T1-weighted, T2-weighted, T2-fat-suppressed, short inversion time inversion recovery, and contrast-enhanced sequences. Two experienced musculoskeletal radiologists blindly and independently noted their degree of confidence in malignancy using all available images/sequences for each patient. For CAD, tumors were segmented in three dimensions using T1-weighted images. Gray-level co-occurrence and run-length matrix textural features, as well as morphological features, were extracted from each tumor volume. Combinations of shape and textural features were used to train multiple, linear discriminant analysis classifiers. We assessed sensitivity, specificity, and accuracy of each classifier for delineating lipoma from liposarcoma using 10-fold cross-validation. Diagnostic accuracy of the two radiologists was determined using contingency tables. Interreader agreement was evaluated by Cohen kappa.
Results
Using optimum-threshold criteria, CAD produced superior values (sensitivity, specificity, and accuracy are 85%, 96%, and 91%, respectively) compared to radiologist A (75%, 83%, and 80%) and radiologist B (80%, 75%, and 77%). Interreader agreement between radiologists was substantial (kappa [95% confidence interval] = 0.69 [0.48–0.90]).
Conclusions
CAD may help radiologists distinguish lipoma from liposarcoma.
... 결정하는 데 중요한 역할을 한다고 할 수 있다. [4][5][6] 본 론 Figure 11. A 65-year-old male with normal lymph node. ...
... 특징적으로 'onion-ring' 모양의 내부 에코를 보이는데, 이는 케라틴 물질이 여러 겹의 layer를 이루고 있기 때문이다. 파열이 발생한 경우에 는 통증이 동반되며, 초음파에서는 불규칙한 모양을 보이게 되고 내부에 혈관성이 증가하여 고형성 종양으로 오인될 수 있다.[2][3][4][5][6][7][8] ...
A wide variety of superficial soft tissue masses may be seen in clinical practice and imaging modalities can be helpful in achievement of a definitive diagnosis or limit a differential diagnosis. Among them, ultrasonography is well suited for screening soft tissue masses because of its safety, low cost, and real-time dynamic imaging. The purpose of this article is to review the characteristic sonographic appearance of soft tissue masses in the extremities.
... In addition, certain soft-tissue tumors have similar appearances between benignancy and malignancy; this phenomenon frequently leads to the delayed diagnosis without adequate initial management (1). If malignant tumors can be diagnosed correctly, patients' survival rate will be increased (1,4,5). ...
... Several imaging modalities have been used to assess softtissue tumors, with sonography being the preferred first-line screening tool in the clinic because of its advantages of low cost, nonionizing radiation, and real-time imaging. But some reports have indicated that sonography is limited to the differentiation between cysts and solid masses (5)(6)(7)(8). Moreover, the sonographic examination relies heavily on the radiologists' experience, so the reproducibility is hard to maintain among different measures. ...
... But until now no further studies have been conducted to apply the combination of morphologic and texture feature sets for analyzing the soft-tissue tumors via sonography (10). Most benign tumors have regular shapes and have hypoechoic, homogeneous echotexture, and well-defined margin, but the malignant tumors have no such appearances (5,11,12). Owing to the infiltration nature of malignancy, morphologic features of benign and malignant tumors are shown with different characteristics. In addition, these morphologic features are nearly independent to ultrasound settings. ...
Computer-aided diagnosis (CAD) is based on shape and echogenicity of tumors and is used to extract relevant information. The various steps of the general CAD algorithm for tumor diagnosis are discussed in this chapter. A CAD system that integrates these features has been proved to be capable of assisting radiologists in the diagnosis of soft-tissue tumors on sonography. Thus, in the characterization of benign and malignant soft-tissue tumors, the CAD system successfully implements the classification using two types of feature sets, including morphological and texture features. Notably, the performance of the morphological features seems to be more relevant in the determination of the tumor status. Nevertheless, both morphological and texture features remain the most important properties while visually interpreting soft-tissue tumors.
